POS0195 PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS HAVE AN INCREASED RISK OF MORTALITY, MECHANICAL VENTILATION, AND HOSPITALIZATION FROM COVID-19
Authors: S. Bruera, X. Lei, H. Zhao, J. Yazdany, M. Chavez-Macgregor, S. Giordano, M. Suarez-Almazor
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with systemic lupus erythematosus (SLE) may have an increased risk of mortality from COVID-19 due to underlying immunosuppression, comorbidities, and abnormalities in the innate immune system. Studies have shown that autoimmune diseases and some immunosuppressive agents are risk factors for hospitalization, ventilation, and mortality from COVID-19. Objectives To compare the outcomes of patients with or without SLE who were diagnosed with COVID-19 and to identify the factors associated with 30-day hospitalization, mechanical ventilation, and mortality. We hypothesized that patients with SLE had a higher risk of adverse outcomes. Methods This retrospective cohort study used the deidentified Optum COVID-19 electronic health record dataset to identify adult patients with COVID-19 diagnosis from 1/1/2020 – 12/31/2020. The SLE cohort was defined as patients who had two or more international classification of diseases (ICD) 9 or 10 diagnosis codes of 710.0 or M32.xx but not M32.0 within one year before COVID-19 diagnosis and were on either antimalarial or immunosuppressive therapy. The general cohort excluded patients with SLE. We matched SLE cases with controls at a ratio of 1:10 by age, sex, race and ethnicity, and month of COVID-19 diagnosis via a propensity score matching with exact matching for the latter three variables. Outcomes included 30-day mortality, hospitalization, and mechanical ventilation after COVID-19 diagnosis. We performed multivariable logistic regression models to estimate the odds of 30-day mortality, hospitalization, and mechanical ventilation after adjusting for age, sex, race and ethnicity, COVID-19 diagnosis quarter, insurance, region, severe obesity, smoking status, and comorbidities. Results We included 687 SLE cases matched with 6,870 controls. After matching, the 30-day mortality for SLE and control was 3.6% and 1.8% (p &lt;0.001), the 30-day mechanical ventilation was 6.0% and 2.5% (p &lt;0.001), and 30-day hospitalization was 31.0% and 17.7% (p &lt;0.001). After multivariable adjustment (Table 1) for age, sex, race, COVID-19 diagnosis quarter, insurance, region, severe obesity, and smoking status, patients with SLE had higher odds of death (Odds Ratio (OR)=2.09; 95% CI 1.31-3.32), mechanical ventilation (OR=2.43; 95% CI 1.67-3.54) and hospitalization (OR=2.06; 95% CI 1.71-2.49). After additionally adjusting for comorbidities, the OR decreased to 1.39 (95%CI 0.79-2.44), 1.81 (95%CI 1.16-2.82), and 1.32 (95%CI 1.05-1.65) for mortality, mechanical ventilation, and hospitalization respectively. Older age, male sex, Hispanic ethnicity or Black race, severe obesity, and smoking had increased risk of adverse outcomes. Table 1. Multivariable logistic regression model of 30-day mortality, 30-day mechanical ventilation, and 30-day hospitalization on matched cohort adjusting for demographic and comorbidity score Variables Model 1*Odds Ratio (95% CI) Model 2**Odds Ratio (95% CI) Mortality Control 1 1 SLE 2.09 (1.31 to 3.32) 1.39 (0.79 to 2.44) 30-day mechanical ventilation Control 1 1 SLE 2.43 (95% CI 1.67 to 3.54) 1.81 (1.16 to 2.82) Hospitalization Control 1 1 SLE 2.06 (1.71 to 2.49) 1.32 (1.05 to 1.65) SLE: systemic lupus erythematosus; CI: confidence interval. *Model 1 includes adjustments for age, sex, race, COVID-19 diagnosis date (by quarter), insurance, region, severe obesity, smoking status, and skilled nursing facility stay three months before COVID-19 diagnosis. **Model 2 includes adjustments from model 1 and comorbidities (excluding SLE). Conclusion Patients with SLE have an increased risks of mortality, mechanical ventilation, and hospitalization within 30 days of COVID-19 diagnosis. The risks decreased after adjustment for comorbidities but remained statistically significant for mechanical ventilation and hospitalization. Disclosure of Interests Sebastian Bruera: None declared, Xiudong Lei: None declared, Hui Zhao: None declared, Jinoos Yazdany Consultant of: She has performed consulting for Aurinia, Astra Zeneca, and Pfizer, unrelated to this work., Grant/research support from: Dr. Yazdany has research grants from Astra Zeneca, Gilead and the Bristol Myers Squibb Foundation unrelated to this work., Mariana Chavez-Macgregor: None declared, Sharon Giordano: None declared, Maria Suarez-Almazor Consultant of: Dr, Suarez-Almazor has been a consultant for Pfizer, Eli Lilly, Chemosentryx, Bristol Myers Squibb. All unrelated to the topic of this study.